Long-Acting Injectables: The Future of HIV Care?

Segment Description: W. David Hardy, MD, adjunct professor of medicine in the Division of Infectious Disease at Johns Hopkins University, discusses long-acting injectable agents in the pipeline.

Interview transcript (modified slightly for readability):

Contagion®: There are a couple different forms of long-acting injectable therapy in the pipeline (ex: cabotegravir and rilpivirine). Can you review what those are and how they would revolutionize treatment?

W. David Hardy, MD: There are some very exciting new long-acting injectable medications—2 to really speak of. One called intramuscular injected cabotegravir, an integrase inhibitor, which is very similar to a currently licensed medication called dolutegravir. Cabotegravir, I should say, is still investigational. It's not been approved by the FDA for any indication yet. The second medication that is given with a cabotegravir is injectable rilpivirine. Rilpivirine is an approved medication in a tablet form but not in an injectable form.

When these 2 medications have been put together—basically an intramuscular injection in 1 side of the butt and a second intramuscular injection in the other buttock—there has been early data, phase 2 data, that shows that the medication really works very, very well in terms of keeping the viral load suppressed after it has been suppressed with oral medications first. I think that's an important thing to think about is that people have to be on oral medication first prior to then switching to the every month, or every 2 month, injections with the cabotegravir and the rilpivirine intramuscular injections so this is really a maintenance of suppression after it has already occurred. Whether or not the injectables could be used from the very beginning has not been tested yet and is something that will hopefully be tested sometime in the future.

The phase 3 studies, 2 large phase 3 studies, using cabotegravir and rilpivirine injectables are going to be discussed at a upcoming conference in about 3 weeks (Annual Conference on Retroviruses and Opportunistic Infections CROI) so there's a lot of excitement to see what these 2 really definitive studies comparing injectables to oral medications are really going to tell us